Dr Nonye Ezeh (ST3 Trainee), Dr Teim Eyo (ST5 Trainee) and Dr Olayinka Kowobari (Consultant Neonatologist)

Congratulations, and welcome to this unique society of Paediatricians and Paediatric postgraduate doctors in training in the UK. Graduating from medical training outside the UK and possibly practising in a system different from the NHS bring unique strengths and challenges.

Firstly, you likely have different life, clinical and training experiences which have shaped your understanding and practice of caring for children.

Secondly, your ways of working with other professionals within the clinical care of children may be very different.

Your understanding and experiences of assessments and progression within the speciality are likely quite different. It may be a challenge in itself to decipher your unique learning curve.

After all, you need to know what you don’t know to attempt flattening the unknown curve!

Add to these the new challenges with using infrastructure within the UK health system, governance and litigation scares, language and the wider communication barriers, cultural differences and the all-too-familiar syndrome of ‘the new kid’.

Don’t worry.

You are certainly not alone.

Many people share your anxieties, either historically or currently.

Our aim in the highlights below is to provide you with some tips and guiding principles to navigate this wonderful speciality full of opportunities for career fulfilment and personal development.

1. Be strategic. It is so easy to get overwhelmed with so much to do within a short time more so during the relocation phase. Hence, it pays to strategise your move, especially when moving with your family. Speak to colleagues who have gone through a similar journey. If you do not know any colleagues yet, Soft landing is a good place to start.

Leverage the Human Resources Department of your new workplace. They can assist with everything from accommodation to opening salary accounts and even sorting out travel expenses. To truly feel settled, get clued up on your new area, especially if you have young children. Sorting out schooling and childcare will make a huge difference in settling both on the work front and at home.

2. Be open to objective assessments of your knowledge and capabilities, ready to learn and be led by a system full of structures and safeguards. Remember that ‘difference’ does not define ‘standard’. There is a reason for the structure you see. Be proactive and humble as you explore potentially new and different approaches to a field you may have previously considered familiar. Prioritize, and address your issues based on this. Be objective and holistic when you consider your priorities. Remember that what matters to you the most may not be understood by others. Draw confidence from your journey up till now and create lasting structures. You may not be able to sort out all the issues at the start. It is okay to build up success as you go along.

3. Understand the NHS structure, the training structure and how to use your e-portfolio. It pays to have a basic understanding of how the NHS or the organization you are working for operates. Some hospitals even have IMGs handbook- read them! Clarify your job roles and whom you are meant to be reporting to as well as who to raise concerns with. Understand the importance of a multidisciplinary team in the provision and delivery of patient-centred care. For example, get to know who your clinical director, educational/clinical supervisors, ward managers and other members of the team are. Similarly, if in training or planning to go into training, take time to understand the requirements for a successful application and interview. Keeping evidence is key! Be sure to keep an E-portfolio to evidence your competencies as soon as possible. Using the RCPCH E-portfolio is helpful especially if you have training in view. Take advantage of E-training opportunities in general, including webinars, free and affordable courses and modules and your Trusts’ mandatory training. Make sure to keep a log and evidence of attendance and certificates.

4. Stay up to date with guidelines. The majority of the trusts have guidelines for most clinical situations and others like when to call in the consultant, what situations merit incident reports, how to manage various conditions as per standardized National, regional, or specialist guidelines and protocols and lots more, There is the APLS and Newborn Life Support and It is worthwhile getting familiar with these as well as knowing where to easily get these for quick reference. Some trusts have downloadable guidelines and apps too. Even in common clinical situations, using guidelines ensures standardization of care. For example, knowing the preferred first-line antibiotics to start or baseline investigations. You are also likely to be viewed as a better and safer clinician if you refer to guidelines.  

5. Know when to escalate and don’t forget to document. We all have varying degrees of expertise and experience. It’s thus important to know and appreciate your limit as this will allow you to escalate in a timely fashion. Also, some situations demand the presence of seniors/consultants despite your ability to manage them due to medico-legal reasons so be sure to identify these. In addition, any situation you feel out of your depth or are unsure of, that’s a situation to get the senior’s advice and/or presence. Be open to learning from every member of the team. Solutions can be provided by any of the team and in the same way, difficulties and challenges can occur to even the most senior member of the team. Therefore, have a very low threshold to ask for help, including from other non-medical members of the clinical team as appropriate. Whatsmore, practice being thorough with your documentation– document reviews, changes, escalations, plans, safety netting advice, procedures and discussions with parents. Occasionally, you may find yourself in situations where you need to provide police statements, write reports, raise concerns, or address complaints. If faced with such circumstances, it’s essential not to be discouraged. Instead, seek support from relevant sources, involve your medical defence union at an early stage, and, most importantly, reflect on these experiences and learn from them.

6. Identify, track your learning needs. It’s important early on to identify your learning needs and make a plan on how to improve. Also, have early discussions with your educational/clinical supervisor to help streamline these needs and help with signposting. Complete all mandatory training promptly and engage with orientations as these would make you feel more confident. Don’t shy from asking questions at orientations -ask to clarify any unclear area, and if possible, make a list of questions before the day and check anything addressed.

Ask questions at other opportunities beyond orientation wherever you are not clear. Be intentional in your learning and make every patient encounter a learning experience. Make use of mini-cexs, reflections and case-based discussions and read round cases. Offer to present teachings on cases you’ve learned from and attend courses. By doing these, you will notice a gradual increase in your competence and confidence which will also positively impact your patient care. And yes, do attempt the MRCPCH exams when you feel ready. It is very important to ask for feedback contemporaneously and to understand how to utilize feedback effectively. Make sure to ask for feedback from appropriate people.

7. Have a paediatric buddy and build a support system. There is a saying that life is meant to be lived together. This is even more true in Paediatrics. Being an IMG in Paediatrics in the UK can be daunting without a good support system. The cultural differences and the various adjustments can seem overwhelming, hence try to build support systems early on. Look for pediatric buddy/ies who are keen and able to listen and guide you through your career. There are lots of mentoring schemes that you may find useful- check what is available in your deanery/trust. In addition, reach out to the IMG Rep in your deanery/trust and groups like BAPIO (Indian descent) to signpost you to people with similar passions.

8. Ask for shadowing opportunities. The shadowing period allows you to gradually ease into a new work system with the least amount of pressure. During that period, do not be afraid to ask as many questions as you can no matter how silly you feel it may be. Also shadow seniors and other colleagues in different situations like taking consent, breaking bad news and lots more to get better at these. Again, ask for feedback contemporaneously during your shadowing period, and work with your clinical and educational supervisors to interpret and utilize such feedback in your learning.

9. Engage with educational activities. This can take the form of departmental teachings, seminars, simulations, courses or conferences. Do engage with as well as volunteer to deliver teachings, do journal reviews, and update guidelines and information leaflets. There are exciting educational materials which will increase your knowledge base quickly such as DragonBytes, PaediatricFOAMEd, Don’t Forget the Bubbles and Paediatrics for IMG. Get involved in audits, QI and if possible, research. Conferences are a good place to widen your network. Join Relevant Academic and professional groups depending on where areas of your interest such as BAPM (Neonates), BPNA (Neurology), BAPN (Nephrology) and lots more. Joining these groups is usually subsidized for non-consultant-grade doctors. Do explore groups in your interest areas, engage, keep up-to-date, and network! These would also be useful in the future should you choose to subspecialise. There are also opportunities waiting to be had like fellowships, OOPE. Do take advantage of these. Yes, you can do OOPE as an IMG in training with a tier 2 visa!

10. Work-life balance. Balance is key!  Ensure you match the pressures of work with enjoyable activities that help you relax. Do not shirk from what you love to do and don’t lose your individuality amid the grind of work. Do what makes you tick- that could be baking, cycling, walking the dog, singing, dancing, nature strolls, watching movies, or just hanging out with loved ones. This would boost your mental health, rejuvenate and refresh you thereby ensuring that you can give your best when you are at work. If at any time, you feel overwhelmed, speak to your educational/clinical supervisor, there is deanery support as well, some hospitals have psychological support for staff

and the Occupational Health department of your hospital is also brilliant in providing support. Find healthy ways to integrate into your new home and work environments. Sharing time, ideas, food/ delicacies and events are usual ways of getting to know people and being known anywhere. Consider these and do not shy away. Remember, it is difficult to build trust in mystery.  Be kind to yourself. It takes time to learn, adapt and adjust. So, give yourself time! Sometimes we are our worst critics. Celebrate little wins and develop a positive outlook. Take breaks. Ensure to keep hydrated and eat as healthy as possible. Practice good habits on night shifts and pace yourself.

Finally, welcome aboard this ride that promises to challenge you to become a better version of yourself, while leading you to success!

It’s time to bring those dreams to reality.

Dr Nonye Ezeh (ST3 Trainee), Dr Teim Eyo (ST5 Trainee) and Dr Olayinka Kowobari (Consultant Neonatologist)